What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Large vessel occlusion (LVO) ischemic stroke (n=7427). Intervention: Tirofiban vs. Control. Primary outcome: Symptomatic intracranial hemorrhage (sICH) (OR 0.93, 95% CI 0.78-1.11).

What question did this study set out to answer?

To evaluate the safety and effectiveness of tirofiban when used with endovascular thrombectomy in LVO ischemic stroke patients.

June 27, 2026Open Access

Safety and Efficacy of Tirofiban as an Adjunct to Endovascular Thrombectomy in Large Vessel Occlusion Stroke: A Systematic Review and Meta-analysis with GRADE Assessment

Key Result

Tirofiban as an adjunct to endovascular thrombectomy in LVO stroke showed no significant difference in symptomatic intracranial hemorrhage compared to control (OR 0.93; 95% CI 0.78-1.11).

Key Points

To evaluate the safety and effectiveness of tirofiban when used with endovascular thrombectomy in LVO ischemic stroke patients.
Comprehensive systematic review of RCTs and observational studies
Electronic searches across major databases up to October 2024
Statistical analysis performed using RevMan software with odds ratios for dichotomous outcomes.
30 studies included, comprising 28 cohort studies and 2 RCTs
No significant difference in symptomatic and asymptomatic intracranial hemorrhage between groups (OR 0.93, 95% CI 0.78 to 1.11 for sICH)
IV+IA tirofiban administration reduced the risk of asymptomatic intracranial hemorrhage (OR 0.68, 95% CI 0.49 to 0.94).

Study Design

Type

Meta-Analysis (n=7,427)

Structured PICO

Does tirofiban as an adjunct to endovascular thrombectomy reduce intracranial hemorrhage or improve functional outcomes in patients with large vessel occlusion ischemic stroke?

Population

Meta-analysis of 30 studies (28 cohort, 2 RCTs) including 7,427 cases evaluating tirofiban as an adjunct to endovascular thrombectomy in patients with large vessel occlusion ischemic stroke.

Intervention

Tirofiban (intravenous, intraarterial, or both) as an adjunct to endovascular thrombectomy

Comparator

Endovascular thrombectomy without tirofiban (control group)

Outcome

Symptomatic intracranial hemorrhage (sICH)safety

Tirofiban as an adjunct to endovascular thrombectomy in LVO stroke appears safe, with the IV+IA dosing strategy potentially reducing asymptomatic intracranial hemorrhage and improving 3-month mortality and functional outcomes.

Main Result

Odds Ratio: 0.93 (95% CI 0.78–1.11)

Abstract

BACKGROUND: We conducted a comprehensive systematic review and meta-analysis of RCTs and observational studies comparing the effectiveness and safety of tirofiban as an adjunct to endovascular thrombectomy (EVT) in patients with large vessel occlusion (LVO) ischemic stroke. METHODS: We performed electronic searches across Medline through PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from inception to October 2024. Statistical analysis was conducted using RevMan software (version 5.4.1). Odds ratios (OR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes under 95% confidence intervals (CI). RESULTS: A total of 30 studies (28 cohort studies and 2 RCTs) were included in the systematic review. Of these, 28 studies comprising 7,427 cases contributed data for the analysis of symptomatic intracranial hemorrhage (sICH). There was no significant difference between tirofiban and control groups even after doing subgroup analysis based on the route of tirofiban administration (OR 0.93, 95%CI = 0.78 to 1.11). The pooled data revealed no significant difference between both groups (OR 0.92, 95%CI = 0.62 to 1.35) regarding asymptomatic intracranial hemorrhage (AsICH). On doing subgroup analysis based on the route of tirofiban administration, only the tirofiban intravenous (IV)+ intraarterial (IA) group demonstrated a lower probability of having AsICH compared to the control group (OR 0.68, 95%CI= 0.49 to 0.94). CONCLUSION: Using tirofiban as an adjunct to EVT in patients with LVO stroke is demonstrated to be safe and effective, especially when using IV+IA dosing of tirofiban, which reduced the risk of AsICH, 3-month mortality and increased the incidence of good functional outcomes presented by modified Rankin score.

KI fragen

Bookmark

View Full Paper